Provider Demographics
NPI:1932969334
Name:WEIGHT LOSS AND VITALITY CENTER LLC
Entity Type:Organization
Organization Name:WEIGHT LOSS AND VITALITY CENTER LLC
Other - Org Name:C.C.C. WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:140-490-2082
Mailing Address - Street 1:5686 FULTON INDUSTRIAL BLVD SW UNIT 43992
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30336-3216
Mailing Address - Country:US
Mailing Address - Phone:404-902-0821
Mailing Address - Fax:
Practice Address - Street 1:360 RACETRACK RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-1022
Practice Address - Country:US
Practice Address - Phone:404-902-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care